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2 results

  • 31 - Acute Mesenteric Ischemia

  • from Section 6 - Gastrointestinal Emergencies
  • Edited by Kaushal Shah, Weill Cornell Medical Center, New York, Jarone Lee, Massachusetts General Hospital, Boston
  • Edited in association with Clark G. Owyang, Weill Cornell Medical Center, New York, Benjamin Christian Renne, Massachusetts General Hospital, Boston
  • Book:
    Practical Emergency Resuscitation and Critical Care
    Published online:
    02 November 2023
    Print publication:
    23 November 2023, pp 293-301

  • Summary

    Mesenteric ischemia is a generic term referring to hypoperfusion of the intestines. It can be either acute or chronic and is caused by several different etiologies. It is a rare but life-threatening vascular emergency, occurring with increasing frequency (0.1% of all hospital admissions) and with mortality rates between 60% and 80%. It affects primarily those older than 50 years with systemic and cardiovascular disease. The acute form is more common and results in rapid intestinal ischemia, infarction/necrosis, sepsis and death. Splanchnic vascular insufficiency in chronic ischemia can also threaten bowel viability.

  • 54 - Pneumonia

  • from Section 9 - Infectious disease emergencies
  • Edited by Kaushal Shah, Jarone Lee, Kamal Medlej, American University of Beirut, Scott D. Weingart
  • Book:
    Practical Emergency Resuscitation and Critical Care
    Published online:
    05 November 2013
    Print publication:
    24 October 2013, pp 362-366

  • Summary

    This chapter discusses the diagnosis, evaluation and management of acute mesenteric ischemia. The diagnosis should be considered in those older than 50 years, presenting with nonspecific abdominal pain and risk factors for the disease. The physician must have a high index of suspicion as the history of the disease may be difficult to obtain. The chapter lists clinical presentations of the subtypes of mesenteric ischemia. Emergent laparotomy is indicated, especially if signs of peritonitis are present. Surgery is generally the standard of care for mesenteric arterial embolism and thrombosis. Surgery is done to determine the extent of damage, to find the underlying cause, to revascularize viable bowel, and to resect infarcted bowel. Second-look procedures are often performed 24-48 hours after the initial surgery in order to restore continuity and assess extension of ischemia to ensure that at-risk or ischemic bowel is not used for the final anastomosis.